The outcome of Crohn's disease patients refractory to anti-TNF and either vedolizumab or ustekinumab.
Adolescent
Adult
Antibodies, Monoclonal, Humanized
/ therapeutic use
Crohn Disease
/ drug therapy
Female
Gastrointestinal Agents
/ therapeutic use
Humans
Male
Proportional Hazards Models
Remission Induction
Retrospective Studies
Treatment Failure
Tumor Necrosis Factor-alpha
/ therapeutic use
Ustekinumab
/ therapeutic use
Young Adult
Anti-TNF
Biologics
Crohn's disease
Ustekinumab
Vedolizumab
Journal
Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver
ISSN: 1878-3562
Titre abrégé: Dig Liver Dis
Pays: Netherlands
ID NLM: 100958385
Informations de publication
Date de publication:
10 2020
10 2020
Historique:
received:
19
06
2020
revised:
25
07
2020
accepted:
26
07
2020
pubmed:
24
8
2020
medline:
5
8
2021
entrez:
24
8
2020
Statut:
ppublish
Résumé
The aims of this study were to describe outcomes in patients with Crohn's disease who fail anti-tumor necrosis factor (TNF) and either vedolizumab or ustekinumab. Multicenter, retrospective study of 100 patients with Crohn's disease who failed anti-TNF and either vedolizumab or ustekinumab from 2015 to 2019. Using multivariable Cox regression, we sought to identify factors associated with need for surgery. 75 patients received a third line treatment, resulting in 23 (30.7%) clinical remission at week 48. Among the 71 patients included after vedolizumab failure, 46 received ustekinumab, resulting in 46 (28.3%) clinical remission; 13 patients were retreated with an anti-TNF, resulting in 13 (46.2%) clinical remission. Among the 29 patients included after ustekinumab failure, 12 were retreated with an anti-TNF, resulting in 2 (16.7%) clinical remission. The rate of surgery-free survival at 48 weeks was 76.5% (95% confidence interval 68.4% - 85.4%). In multivariable analysis, ileal disease localization (hazard ratio 9.0, 95% confidence interval 1.0-81.9) was associated with a higher risk of surgery. In patients with Crohn's disease who have failed anti-TNF and either vedolizumab or ustekinumab, at week 48, the surgery rate is 23.5% and the remission rate after a third line biologic therapy is 30.7%.
Identifiants
pubmed: 32828693
pii: S1590-8658(20)30389-3
doi: 10.1016/j.dld.2020.07.031
pii:
doi:
Substances chimiques
Antibodies, Monoclonal, Humanized
0
Gastrointestinal Agents
0
Tumor Necrosis Factor-alpha
0
vedolizumab
9RV78Q2002
Ustekinumab
FU77B4U5Z0
Types de publication
Journal Article
Multicenter Study
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1148-1155Informations de copyright
Copyright © 2020. Published by Elsevier Ltd.
Déclaration de conflit d'intérêts
Declaration of Competing Interest LK, JK and AM declare no competing interest. AA received honoraria from Abbvie, Hospira, Takeda, Gilead, Biocodex, Janssen, Tillotts, Ferring and MSD. XT received honoraria from Abbvie, MSD, Takeda, Ferring, Norgine and Janssen. MA received honoraria from Abbvie, MSD, Janssen, Takeda, Pfizer, Novartis, Ferring, Tillotts, Celgene and Genentech/Roche. YB received honoraria from Abbvie, Biogaran, Boehringer Ingelheim, Celgene, Ferring, Gilead, Hospira, Janssen, Mayoly-Spindler, MSD, Norgine, Pfizer, Roche, Samsung Bioepis, Sandoz, Sanofi, Shire, Takeda, UCB. LB received honoraria from Janssen, Pfizer, Allergan, AbbVie, Janssen, MSD, Ferring Pharmaceuticals, Mayoly-Spindler, Takeda and Tillotts, and research support from Abbott, Ferring Pharmaceuticals, Hospira-Pfizer, Janssen, MSD, Takeda and Tillotts. FC received honoraria from Amgen, BMS, Enterome, Ferring, Janssen, Medtronic, Pfizer, Pharmacosmos and Roche as well as lecture fees from Abbvie, Astra, BMS, Ferring, Janssen, MSD, Pfizer, Pileje, Takeda and Tillotts.